My mom has dementia and of course this facility boasted everything they provide for both their assisted living and memory care floors. They told us as long as mom was not going to try and leave the building (doors always locked anyway) she would be better of on the higher care plan and be on the assisted living floor. Fast forward to now. I have had several meetings with the director that mom is not taken to the bathroom during the day, she has this week slept in her clothes on the couch because no one came in to help her get ready for bed. This means not changed and no brushing her teeth. She was forgotten about for a dinner tray and offered a peanut butter sandwich last night. Our last discussion on this was the day before the three night streak on the couch. She is always defending her staff and not taking responsibility for anything. She has informed me mom’s level of care is dependent on her mood. If she does not want to go to the bathroom when they initially rush in and ask it is marked as a refusal on a chart in her room. So I am paying 6,600 dollars a month for them to not use any professionalism to distract, re-word the request they immediately mark it off as no care. Am I expecting to much? How else can I handle this with them? At this point I am only wanting her to stay because change is going to be so hard on her. I just want them to do their basic tasks.

Find Care & Housing
Assisted Living is just that - assisted. The resident needs to be able to take care of themselves with help, specifically with meals and housekeeping and medications. It sounds to me like your mom is getting typical AL, but perhaps "they" oversold what you would get in the AL unit vs the MC unit.

My mom with Alzheimers was in AL for about 18 months and did fine with the light touch offered in the least restrictive environment. As her ALZ progressed, she became less able to function on her own (changing clothes, going to the bathroom in time, etc), so that her level of care became greater than AL could manage. The director was kind enough to suggest I start looking into Memory Care and made some suggestions. Once Mom started eloping, the director gave me 30 days. Three days later, she slugged the nurse that tried to tell her she had to do something and we were asked to leave immediately.

Once Mom settled into Memory Care (she was livid about the change and about the locked door during the first week or two), she did much, much better. I realized she NEEDED the extra structure offered by MC. The staff doesn't invite her to dinner but tells her it's dinner time and waits for her to come along with them. They don't give her her meds to take, but give them to her and watches her take them. They come through and insist she get up and go to the bathroom periodically if her Depends is dry or help her change if it isn't.

AL and MC staff have pretty different mindsets. AL is based on giving the resident as much freedom and autonomy as possible while maintaining their basic needs. MC recognizes that the resident can't manage that much freedom any longer and imposed more structure in a more authoritative manner. AL staff doesn't have as much training as MC staff in dealing with dementia and don't understand at well how to navigate around the dementia to get the desired outcome for the best interest of the resident.

It really sounds to me like your mom would benefit from moving onto the MC wing. Making change only gets harder the further into her dementia you get.
Helpful Answer (15)
Reply to mgmbaker
LauraEt Apr 17, 2024
What happens when your Mom's dementia is severe (cannotfeed herself, or navigate on/off toilet, cannot really do anything unassisted? Will she be asked to leave, or?
gettyupgo, Yes, you hit the nail right on the head! This has been my actual observation especially about the pay, the treatment of workers and the "greed" rather than a conscience about the profit and the greater good of caring for our elderly. And lastly, yes the Church related facilities have a better approach.

I moved along with my mother from one end of the country to the other. My mother is 86-years-old with Dementia. I work remotely. Believe it or not, we both live in an Independent Living and I bring in services.

I have said this before and I will say it again. Assisted Living is Real Estate...there is no assistance. Basically, you are given a room, usually a studio or efficiency and everything is a la carte.

Every finance guru nowadays will tell you, don't play the stock market, invest in an Assisted Living. The return can be as much as 30-40%.

Before I moved I was well aware of the level of care that is usually promised in the brochures--"we're like family". This is only in the movies, not in real life.

Why am I here? The blood thinner, Eliquis. There is no way 1 or 2 CNA's can accommodate the dispensing of medications for a floor. Besides, $500-$600 per month for medications is too much for our budget.

The staff is overworked, short-staffed and underpaid, usually women of color or from other countries who barely speak English. When they return home at night, they take care of their own mother who usually resides with them. These women have to walk dogs, clean up dog poop, be called girl by the residents and don't realize the power they have because if they did they would unite and unionized. We need them. The waitresses at a well known breakfast chain who never organized were still working for $2 per hour plus tips only until a years ago. They never organized.

The pay for the employees who do the dirty work is miniscule. The Executive Directors' come and go. They take the brunt from residents, residents families, the employees and have to make their budget work. The owners usually never step foot in the place because they are vacationing on Nantucket Island.

When people call and rant, my father hasn't had a bath in 2-3 weeks, etc. they (the staff) know a family member is not going to show up and bathe them themself. So, it goes back and forth, I'm paying for this. In the mean time, the loved one's needs are not being met.

The Sunday night phone call is not enough. Someone needs to oversee everything--has your loved one eaten, do they have clean clothes on every day and clean underwear. Is the air conditioning unit working properly? Are the medications being taken with food at the right time.

I have witnessed female residents with facial hair, one lady wears the same dress everyday unless she bought more than one. Most are on walkers and the buffets are too much work for them, they struggle.

I think your loved one needs to be moved with a higher level of care. The elderly need to be protected. Their hygiene is important. I oversee everything. I have been billed for services that were not provided and have come at a time that was convenient for them and not when we requested them. Check your bill and don't give them access to a checking account or credit card until you read everything.

I have heard stories where the elderly have stayed in a facility for too long and bedsores were overlooked because they liked their lunch friends and bingo. I have heard other stories that the proper nutrition was not being provided nor sheets cleaned on a weekly basis or as soiled, nor their apartment cleaned and disinfected properly.

There's really not a lot of guidelines for these facilities. The chances of more than one call button going off at the same time are high. There is usually only one LPN or 1 CNA on duty at night. A lot can go wrong at the same time and not enough manpower.

I think a change needs to be made. I know it's hard but I want to be forthright.
Helpful Answer (12)
Reply to Ireland
Riverdale Apr 18, 2024
A church related facility hired a new person,did not properly train her,she went against the protocol for moving my mother attempting to do it herself instead of having assistance from another aid. She dropped my mother and both her femurs were broken. Surgery was done on one leg but could not be done on the other due to hip and knee replacements on that side. Shortly after returning from the hospital she developed a bedsore that turned into osteomyelitis.

Thankfully I moved her to a non church related facility where she eventually passed after much suffering,hospice care including fentanly patches as her pain was so great. She did receive what I believe to be the best care possible by a facility.
This is poor care.
You will have to find another facility.
You have discussed everything with those in charge here and they do not care. I can't see any option but to find another facility. I know this adds tremendously to your burden, but this isn't acceptable care, even if short staffed, and what's worse is the unwillingness to take any responsibility.
Helpful Answer (11)
Reply to AlvaDeer

Assisted living in original concept and design was meant for people who wanted a social life and didn't want to cook dinner or deal with fixing the roof. The "assist" was to remind residents that breakfast was ready. As people have aged, the Assisted Living facilities are for the most part selling people services they can't provide. Based on what you've written, your Mom is above the AL level of care and should be in MC.
Now about the staffing issues. I'm a Certified Assisted Living Administrator, a former long term care Admissions Director, a Board Trustee of a HUD 62+ building and the Vice Chair of our township's Commission on Aging so trust me... I keep my fingers on the pulse of senior living! You are, unfortunately, going to find short and disinterested staff in most places because the bulk of the $8000/mo that you are shelling out is going to the owners, not to the people (LPNs, CNAs, cooks, kitchen and laundry staff) who do the grunt work. Even in states where the min. stage is $15/hr with taxes, a single person is taking home approx. $13.83/ hr which translates to 13.83*40 or 555/mo which comes up to about $30k per year. CNAs have families too and there are not a lot of places that you can rent to live and buy food and clothes for your family on 30K per year. We won't even get into the fact that since we don't really have a national transportation system, you need a car and all that entails just to get to work. Because a lot of people burn out (especially if they care about residents) facilities are having a hard time getting anyone to work so they are going to agencies for staff. Some agency people are great but they are getting even less pay per hour because the middleman, the agency, is taking the bulk of that money. The ones that are not great are so far in the garbage pail, you can't see them. Just got through writing a letter to the Ombudsman about an agency CNA who had to change a resident twice within a few hours and cursed her. Luckily, a caring fellow co worker walking past the room heard her, intervened and reported him. I followed up with a note to the Ombudsman. I'm not saying that more money would guarantee better workers (Lord knows, we have all seen idiots who happen to be CEOs with degrees from great universities) but it would help. I know facility in NJ that pays it entire staff a decent wage and they have people who have been on staff for years. That facility is also a religious one that accepts people of all religions. I have found over 20 years that the religious based facilities, while not a pretty as the for profit one, tend to offer a slightly better level of care.
It's unfortunate, but until we can somehow get the entitled owners to realize that instead of making 18% profit, they can make 15% and send the 3% to their staff, we are going to continue to see shortages and poorly trained staff regardless of what outrageous sums we pay. It's really sad.

If you continue to get no response from the Director, it may be time to find a different facility for Mom but it is likely she will need MC.

Wishing you luck and peace.
Helpful Answer (8)
Reply to geddyupgo
LauraEt Apr 17, 2024
What do you think of an AL/MC facility (not an SNF) that will take your Mother with severe dementia, but only if she's "on hospice" because technically they're not licensed to take severe dementia patients and stated that they need the "extra hands?" To me that screams "violation." This is for profit facility. In Virginia I've noticed the non-profits have far fewer violations and far higher consumer ratings. I think they should all be nonprofits due to the obvious conflict of resident interest.
See 2 more replies
Maybe it's time to look into a nursing home for your mom, where she will be provided with 24h care. Her dementia will only get worse. Assisted living is a money making business, ultimately they don't care, but your mom needs better care now, take action.
Helpful Answer (7)
Reply to NJmom201

I agree, this is poor care. The problem is the ask if a resident wants to go to the bathroom, get a bath, or get dressed. And what does the resident By law u cannot force them. I told an aide don't ask Mom just do it "Peg time to go to the bathroom" or shower or dress or down to to dinner. When said like this my Mom never said no. I never asked when she lived with me it was "time to shower" and she went. Yes, they should try another tactic. For my daughter, RN, she says u have to make them think it was their idea. "Mary, would you not feel so much better getva warm shower and putting on clean fresh clothes" usually the answer was yes.
Helpful Answer (7)
Reply to JoAnn29
Abell01 Apr 11, 2024
I have tried telling them to not ask but say time to eat, or time to go to the bathroom but there is so much turnover with aids that it is constantly starting over. I am so afraid if I move her I am going to find this everywhere and I would have taken away her familiarity
At it's core assisted living is about providing meals and housekeeping plus limited help with bathing, dressing and medication management, I'm always leery of any AL facility that pretends they do more than that.
Helpful Answer (6)
Reply to cwillie
AlvaDeer Apr 11, 2024
I so agree with you cwillie. This ALF has indicated that for the higher level of care they can take care of this woman, and clearly they aren't fulfilling that. I understand all the staffing issues and etc. but this clearly devoted and involved daughter has taken her concerns to them and they have simply negated what she has said. The ALF where my brother was tried so hard to work with clients and families, recognizing that a move to their memory care would be so much more costly, and they had a sort of inbetween care in one cottage where there was more staff, locked facility. But they didn't let clients who clearly needed more care stay where they weren't safe and where they presented a burden to other residents.
Mom needs to be moved from this facility . If you move her , I would just have her go to memory care to avoid the same problem . Better off in memory care where the staff to patient ratio is better . Assisted living is not staffed to take 20 minutes just to talk someone into using the bathroom .
Helpful Answer (6)
Reply to waytomisery
Fawnby Apr 11, 2024
Sometimes it takes even longer than 20 minutes. Staff probably can’t manage her needed level of care where she is.
See 1 more reply
You may be concerned over a transition, but I’d consider how much more comfortable your mom would be with specialized care that Memory Care can provide. After multiple problems, similar to what you describe, I placed my LO in MC and it was an immediate improvement. My LO seemed to relax, since she sensed these people were able to really care for her. They took charge and were trained on how to manage her care. They never had a problem with her refusing a shower. She got 3 a week without issue. She resisted showers at the AL. You might check the AL’s policy on incontinence. Many don’t provide changing of a resident who is double incontinent. With dementia, that is likely to develop.

Good luck with everything.
Helpful Answer (6)
Reply to Sunnygirl1

The staff in most AL will ASSIST but they usually will not cue people to do tasks. If someone needs help with toileting they will not come in every 2 hours and take a person to the bathroom. The person has to notify staff that they need help.

It does sound like your mom needs more help than AL can provide.
It may have been different when she first moved in. With any move a person with dementia will probably decline and this may have happened.
I think it is time that she be transitioned to MC.
Helpful Answer (6)
Reply to Grandma1954

See All Answers
Ask a Question
Subscribe to
Our Newsletter